Despite traditional use of beetroot for antitumor, carminative, emmenagogue, and hemostatic properties, clinical trials are lacking to substantiate these claims. Data suggest a role as an antioxidant, as a natural source of nitrites, and a potential use in cardiovascular conditions, although evidence is limited. In thefood industry, beetroot is used for its color.

BotanyB. vulgaris is an herbaceous biennial growing 1 to 2 m in height. It bears heart-shaped leaves measuring up to 40 cm long in cultivated varieties. The 5-petaled flowers are 3 to 5 mm in diameter, green or reddish tinged, and densely arranged along a long inflorescence. A hard cluster of “nutlets” are formed as fruits. The main root of the beetroot plant is swollen and composed of alternating layers of darker and lighter conductive and storage tissues. 1 , 2

HistoryReferences to beetroot are found in Roman scripts for treating fever and constipation, and for use as an aphrodisiac. Hippocrates is said to have advocated using beet leaves for binding wounds. The plant was used throughout the Middle Ages for a variety of ailments. The term “nature's candy” has been associated with the historical use of sugar from beet in the Napoleonic Wars. Traditional use includes antitumor, carminative, emmenagogue, and hemostatic properties.2 , 3 Beetroot juice is utilized in the food industry as an alternative to synthetic colorants in jams, jellies, and sauces. 4 , 5

ChemistryThe leaves contain varying amounts of calcium, phosphorous, iron, vitamins A and C, niacin, thiamine, and riboflavin. 3 A ribosome-inactivating protein, beetin, has been identified in mature plant leaves. 6 The roots mostly consist of saccharose and the same elements and vitaminsfound in the leaves, as well as folate, zinc, and magnesium. The color is mainly derived from water-soluble nitrogenous pigments called betalains: betacyanins (red) or betaxanthins (yellow), including betanin, betanidin, betalmic acid, and vulgaxanthin. 4 , 7 , 8 , 9 Heat labile phenolic acids and flavonol glycosides have also been described. 4 , 8 Assays of the chemical constituents have been performed by high-performance liquid chromatography and spectrophotometry. 10 , 11

Beetroot Uses and Pharmacology

AntioxidantIn vitro experiments in human blood and in rats indicate antioxidant activity of the betacyanins, including betanin and betanidin. Decreased sensitivity of low-density lipoproteins to oxidation, and prevention of active oxygen-induced and free radical–mediated oxidation of molecules, has been described. 4 , 5 , 10 , 11 , 12 In rats, increases of copper and zinc in the liver protecting against reperfusion injury was suggested to be via superoxide dismutase action. 13

CardiovascularDecreases in systolic and diastolic blood pressure were recorded for healthy volunteers after consumption of a single dose of beetroot juice. 14 A peak effect was recorded at 3 to 4 hours. Endothelial dysfunction following an acute ischemic insult was prevented and platelet aggregation was attenuated ex vivo. The effects were attributed to nitrates in the beetroot. Clinical trials among patients with cardiovascular conditions are lacking.

OtherOlder data include animal experiments in mice, evaluating efficacy against skin and lung cancer, but this line of investigation does not appear to have been pursued outside of epidemiological data and antioxidant activity. 5

DosageLimited data are available to support therapeutic dosing; 500 mL of beetroot juice has been administered as a single dose in healthy volunteers and is estimated to contain approximately 360 mg of betanin. 10 , 14

Pregnancy/LactationInformation regarding safety and efficacy in pregnancy and lactation is lacking. Beetroot has been used traditionally as an emmenagogue and in the treatment of fibroids, but clinical trial data are lacking. Cattle fed large amounts of sugar beet leaves showed infertility and genital tract abnormalities; mice showed increases in uterine weight. Isoflavones are reported to have been detected in the seeds of certain sugar beet varieties. 3

InteractionsNone well documented.

Adverse ReactionsCross-sensitivity to sticky weed ( Parietaria ) and beet has been recorded. 13 Beeturia (red urine after eating beetroot) is found in approximately 15% of the population, 5 and coloration of the blood has also been documented (with no apparent consequence). 15

ToxicologyData are limited. Accumulation of metals (copper, iron, magnesium, manganese, phosphorus, and zinc) in the liver with excess consumption is possible, and was demonstrated in rats. 7Caution is warranted in patients with hemochromatosis or Wilson disease. 7

Conclusie"Dietary nitrate provides a viable option to finally exploit the NO pathway, which has been implicated at multiple steps in the genetic architecture of blood pressures and is a therapeutic modality targeted at gene products directly implicated in raised blood pressure", concluderen de onderzoekers."With large populations of inadequately treated patients with hypertension at higher risk of cardiovascular diseases, an additional strategy, based on intake of nitrate-rich vegetables, may prove to be both cost-effective, affordable, and favorable for a public health approach to hypertension."